Summary:We describe the rare occurrence of a granulomatous pneumonitis seen in a patient following allogeneic bone marrow transplantation. Interestingly sarcoidosis was diagnosed in the marrow donor less than a year after donating his bone marrow. Bone Marrow Transplantation (2001) 28, 627-630. Keywords: alveolitis; extrinsic allergic; sarcoidosis; bone marrow transplantation; granuloma
Case report, recipientA 37-year-old white female presented with a lump in her neck in November 1996. Biopsy revealed a large B cell lymphoma. Chest and abdominal CT scans showed axillary, mediastinal and retroperitoneal adenopathy and a solitary left pulmonary nodule. Bone marrow examination was negative for lymphomatous involvement. She received six cycles of chemotherapy comprising cyclophosphamide, adriamycin (total dose 300 mg/m 2 ), procarbazine and prednisone. Follow-up evaluations showed progression of disease with an increase in axillary adenopathy and the appearance of bilateral pulmonary nodules. She was then given salvage chemotherapy with etoposide, methylprednisolone, cisplatinum and cytarabine.She underwent an HLA-identical bone marrow transplant from her brother in June 1997. The HLA type was A (1,26); B(8,49); Bw(4,6); Cw (7,-); DR1;11030ء DR1.2031ء The conditioning regimen consisted of VP-16, 60 mg/kg and TBI dosing of 225 cGy for 6 days. She received methotrexate and cyclosporine for graft-versushost disease (GVHD) prophylaxis and engrafted on day 13 following the transplantation. She developed a skin rash 140 days following the transplant and was treated for cutaneous GVHD with prednisone and cyclosporine that were tapered off in July 1998. A chest X-ray in June 1998 showed a small ill-defined opacity in the right lower
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